All of the following four criteria must be met (for further details, please refer to the International Standard for Therapeutic Use Exemptions for WADA 2021 (ISTUE), Article 4.2):
1. The athlete has a diagnosed medical condition, which requires treatment using a prohibited substance or method;
2. The therapeutic use of the substance will not, on the balance of probabilities, produce any additional enhancement of performance beyond what might be anticipated by a return to the athlete’s normal state of health;
3. The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative;
4. The necessity to use that substance or method is not the consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.